They ate fewer vegetables and more added sugars, saturated fats, sodium, and overall calories, Cha said, suggesting that more preventive health messaging is needed in this population.

"We need to pay attention to these younger people and teach them what to do," Cha said. "After this study, I don't trust in 'healthy obesity' anymore. They may be healthy at this time, but in 6 months to a year, they will not be healthy anymore."

There has been significant criticism of existing obesity definitions and cardiometabolic risk assessment tools, particularly with regard to body mass index (BMI), Cha said, adding that some studies have shown that EOSS may be a better predictor of risk.

It includes five stages, ranging from obesity with no metabolic abnormality (stage 0), to preclinical conditions such as prediabetes (stage 1), comorbidity such as type 2 diabetes, hypertension, or dyslipidemia (stage 2), end-organ damage such as heart failure (stage 3), and severe disability (stage 4).

The researchers compared EOSS criteria with diet and lifestyle factors among 106 overweight and obese young adults in the Atlanta metro area. About three-quarters (77%) were female and 73% were African American, and the majority (79%) fell into EOSS stage 2 obesity.

Cha and colleagues saw significantly higher BMI among those in those in stage 2 compared with stages 0 and 1 (P=0.022).

When it came to dietary habits, those with stage 1 or 2 obesity generally ate fewer vegetables and less dietary fiber, and had more added sugars, saturated fat, sodium, and overall calories than those in stage 0, they reported. They also ate more fried foods and late-night snacks.

Those habits were reflected in poorer scores on a dietary quality assessment tool, the Dietary Quality Index Revised for Young Adults (DQIR-Y), than those in stage 0, Cha said.

Patients with stage 1 and 2 obesity also drank more sugar-sweetened beverages, and those in stage 2 had the highest consumption of diet soda -- an indication that they may be aware of their condition and trying to change it, she said. Another sign of that awareness was seen in stage 2 patients' physical activity levels, which were higher than patients with stage 0 and 1 obesity.

Cha concluded that the results suggest a need for more public health prevention messaging in these groups in order to combat obesity and its related comorbidities such as cardiovascular disease. That includes better education on the right beverage choices, dietary quality, and physical activity, she said.

Cha also called for her results to be replicated with a larger sample, and for participants to be followed over a longer period of time.

The study was supported by the National Institute of Nursing Research and the Atlanta Clinical and Translational Science Institute.

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